Staying in the Game

Rest resolves most youth sports injuries, but specialization can lead to surgery

By Kurt Dusterberg

Published: August 28, 2018

Photo by Africa Studio/Shutterstock.com

If you have a child who excels at a favorite sport, you’ve probably found yourself caught up in the busy world of travel and club sports — high-level teams designed to maximize performance and exposure for your budding star athlete.

Before you know it, your son or daughter is playing for multiple teams, traveling to tournaments, practicing constantly and even taking private lessons. For many families, the end game is to land a college athletic scholarship. But, oftentimes, injuries are the more likely outcome — at least in the short term.

With increased specialized sports participation comes the likelihood of overuse injuries, and the cause is obvious to orthopedic doctors. Many kids today “specialize” in one sport, rather than play a variety of sports in different seasons. As a result, these athletes stress their growing bodies in the same joints and muscles without enough downtime. The good news is that most injuries to young athletes are easily treated with rest.

All You Need is … Rest

Dr. William Hage, M.D., specializes in arthroscopic treatments for knee and shoulder injuries at EmergeOrtho, which has multiple locations throughout the Triangle. He estimates that 90 percent of the injuries he treats are sports-specific. Baseball players usually suffer from shoulder and elbow pain in the throwing arm, while soccer players often deal with inflammation around the knee and heel.

“I see so much more of that because kids are playing the same sport all year round and not switching gears,” Hage says. “Trying to tell the parents that that’s the source of the problem as well as the key to healing is the challenge. They’re afraid they are missing some opportunity for their kid to move up the ranks.”

Hage says he spends a lot of time trying to convince parents and kids that time on the sidelines is the only way to heal completely.

“It sometimes takes six to eight weeks of rest or modified rest, where they are still participating,” he says. “In baseball, maybe you’re still hitting or taking fielding practice, but you’re not pitching. In soccer, do the drills, but maybe you don’t need to play in the scrimmages. The outcomes if you rest are amazing. Kids heal incredibly well almost every time. If you don’t rest, and you push through the pain, usually kids just break down.”

When Surgery Becomes Necessary

Some injuries do require surgery to get back in the game, whether they are caused by overuse or an acute traumatic injury, such as a collision or a stressful movement. Baseball pitchers are vulnerable to stretching and tearing the ulnar collateral ligament (UCL) in the elbow, which requires a ligament reconstruction procedure known as Tommy John surgery. Athletes who play cutting and pivoting sports such as basketball, football and soccer are prone to tearing the anterior cruciate ligament (ACL) in the knee, which also requires surgery to return to sports.

So what can you expect if your child needs to go under the knife to get back in the game? The surgeries that treat most routine sports injuries have been in place for many years, and they typically return the athlete to full strength. While these procedures haven’t undergone significant innovations in recent years, there have been some advances that make the process easier on the patient.

“Surgeries in general are becoming more minimally invasive,” says Dr. Jocelyn Wittstein, M.D., a sports medicine orthopedic surgeon for Duke Health. “All these procedures on adolescents are outpatient procedures. They’re going home the same day.”

While those short-term improvements make recovery a bit easier, the length of recovery has not necessarily diminished. Wittstein says that in some cases, the time it takes to return to a sport after surgery has increased “because people recognize the risk of re-injury. For ACL tears, we know the risk of re-injury is lower if you return to sport in no sooner than nine months. People used to return to basketball and soccer at six months after an ACL tear. The problem is patience and investing in one’s future versus immediate satisfaction.”

Keep in mind that overuse — throwing too many pitches in baseball, for example — is not the only cause of injuries. Most knee injuries are the result of twisting, awkward landings and the stress of directional change on the joint. So, the more often you play, the more you put yourself at risk.

“These are not necessarily just overuse injuries, they’re just exposure-related,” Wittstein says. “If you have more exposures to cutting and pivoting activity, you’re probably more likely to have a moment where something like that occurs.”

If your child is determined to play a particular sport throughout the year, Wittstein suggests following a preventive injury exercise program that emphasizes balance, flexibility and strength. And when the physical demands of playing the games start taking a toll on your child, take control of the situation.
“Do not overbook them,” she says. “And parents need to communicate with the coaches. You really have to stand your ground.”

Platelet-Rich Plasma Injections

There are some relatively new treatments for healing sports injuries, such as platelet-rich plasma injections. This procedure involves injecting one’s own treated blood into an injured area to promote healing and reduce pain and inflammation. Dr. William Hage, M.D., at EmergeOrtho has used the treatment on adults with tennis elbow, but he does not recommend the procedure for adolescents.

“It’s not something I have done in kids because, number one, kids heal incredibly fast anyway; and, number two, kids hate needles. The idea of doing that with a kid is a little off the standard of care. And frankly, it’s still in a very early, experimental phase.”

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